Inactivity & Immobility Flashcards by Lysza Sabanal

____ is a person’s ability to move around freely in his/her environment

Mobility

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___ inability to move around freely

Immobility

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Is an intervention in which the client is restricted to bed for therapeutic reasons

Bed rest

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mobility is also related to body changes from aging

▫️loss of muscle mass
▫️reduction in muscle strength and function
▫️joint becoming stiffer and less mobile
▫️gait changes affecting balance can significantly compromise the mobility of elder patients

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without the stress of weight-bearing activity, bones demineralize.

disuse osteoporosis

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When muscle fibres are not able to shorten or lengthen

-a permanent shortening (as of muscle) forms, limiting joint mobility

Contractures

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without movement connective tissue at joint becomes _________ (permanently immobile)

ankylosed

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As bone demineralize, excess calcium may move to joints, contributing to stiffness and pain.

calcium leaves the bones and goes to joint cavity, or goes to blood and kidneys and become CALCULI

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A pathological reduction in normal size of muscle fibres after prolonged inactivity from bed rest, trauma, casting, or local nerve damage.

Disuse atrophy

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What are the intervention to decrease atrophy complications?

▫️body repositioning
▫️weight bearing activities 
▫️deep breathing and coughing exercise 
▫️compression stockings
▫️high protein,calories and fibre diet

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Impaired venous return to heart if pooling in extremities

Thrombus formation

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Decreased mobility (CVS) can lead to ⬆️ in ♥️rate ____

reflex becomes dormant, blood pools in extremities _____

tachycardia

orthostatic hypotension

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Bed rest can restrict chest movement. Abdominal organs push against the diaphragm (when laying in bed) restricting lung movement - difficult to expand the lungs fully = shallow respiration’s. fluid gets in the lungs causes atelectasis which leads to pneumonia

poor oxygen exchange at alveolar level

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A stagnation in the normal flow of bodily fluids, such as the blood or urine. Even with voiding in laying position - not emptied completely. ⬆️risk for UTI

Urinary stasis

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Immobility = excessive amounts of urine calcium (extracts from bones). The calcium salts precipitate out as crystals to form _____

Renal Calculi

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Immobility effects to GI due to decreased peristalsis and colon motility

Constipation

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Immobility impedes circulation and diminishes the supply of nutrients to specific area of the skin that causes.

Skin breakdown

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Nursing intervention for immobility/ inactivity

▫️allow patient to perform tasks at his or her own rate
▫️maintain limbs in functional alignment
▫️turn position every 2 hours, or as needed.

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Is a chronic, progressive metabolic bone disease.

-low bone mass, structural deterioration of bone tissue, causing fragility and risk of fracture

Osteoporosis

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Predisposing factors for Osteoporosis:

Long-term corticosteroid use (interferes with bone metabolism)
Prolonged immobilization (usage stimulates “remodeling” - absorption and depositing of bone)
Nutritional deficiency

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Symptoms of Osteoporosis: Often not until later stages of disease “silent disease”

▫️sudden back pains
▫️a decrease in height
▫️kyphosis which is a spine curvature due to bone breakage

Osteoporosis diagnostic Evaluation

▫️DEXA scan (dual energy X-ray Absorptiometry)
▫️Bone density is the most important predictor of fracture risk

**diagnostics don’t diagnose until 25-40% bone density is lost

Modifiable risk factors of osteoporosis (behavioural)

▫️inactivity
▫️alcohol abuse
▫️cigarette smoking

Pharmacological therapy for osteoporosis

▫️Biphosphates (⬇️ rates of bone reabsorption -inhibits osteoclasts activity)
▫️thyroid hormones (slow rate of osteoclasts activity)
▫️selective estrogen-receptor modulators (SERMs)
-estrogen supports bone formation, post menopausal women at risk of OP
▫️Parathyroid hormones
-stimulates bone formation

It’s an inflammation of a joint

Arthritis

It’s a slowly progressing, non-inflammatory disorder of synovial joints. Cartilage wears down over time. Patients may experience a painful bone-on-bone articulation. *Cartilage destruction and inadequate repair

Osteoarthritis

What are the causes of osteoarthritis?

``` ▫️⬇️ of estrogen production (women) ▫️genetics ▫️obesity ▫️exercise ▫️high joint impact sports (soccer, football) ```

Osteoarthritis symptoms:

▫️joint pain (asymmetric) worsening with movement, often relieves with rest (early stages) ▫️joint stiffness (worst in the morning -long rest period) ▫️pain can ⬆️ w changes in barometric pressure ▫️particular mov‘t becomes difficult: sitting, rising from chair ▫️bcoz OA is a non-inflammatory disease, systemic manifestation are not present

Osteoarthritis management: Drug therapy: Supplement: Complementary/alternative:

▫️NSAIDs ▫️glucosamine and chondroitin sulphate ▫️yoga, massage therapy, acupuncture

Three factors collectively predispose a client to the formation of thrombophlebitis (a clot that is loosely attached to an inflamed vein wall)

▫️impaired venous return to heart ▫️hypercoagulability of blood ▫️injury to a vessel wall

A thrombus is dangerous if it breaks loose becoming an ____

▫️Embolus

___% of hip fractures are osteoporosis related

80%

Modifiable risk factor (nutritional)

▫️low calcium intake ▫️low vit.D intake ▫️caffeine intake (⬇️ GI calcium absorption)

Is an infection of the bone caused by staphylococcus aureus

Osteomyelitis

Infection of the bone occurs as a result of:

▫️extension of soft-tissue infection ▫️direct bone contamination (injury) ▫️bloodborne spread from another site of infection (wound)

First line treatment to prevent necrosis in Osteomyelitis

▫️aggressive and prolonged IV therapy (think PICC line)

What will be the risk for extension of infection in osteomyelitis?

▫️bone abscess formation, then cell death

Osteoporosis vs Osteoarthritis

Osteoporosis: loss of bone mass, ⬆️ing risk for fractures Osteoarthritis: degeneration of a joint (knees, wrists, fingers, toes, and hips)

Is a chronic, systematic autoimmune disease characterized by inflammation of connective tissue in synovial joints ▫️fluctuates between remission and exacerbation

Rheumatoid Arthritis

Rheumatoid arthritis management:

``` ▫️rest ▫️joint protection ▫️hot/cold application ▫️exercise ▫️management/prevention of nodular involvement (internal organs) ```

Primary goals in managing RA:

▫️decrease inflammation ▫️manage pain ▫️maintain joint function ▫️prevent or correct joint deformity

Inadequate joint movement can result in progressive____ and ___

Joint immobility and muscle weakness

Over aggressive exercise (OA) can result in _____

⬆️ pain, inflammation and joint damage

_____ exercise (OA) are usually done daily to keep joints functional

gentle ROM

It is a systematic inflammatory disease involving _____, _____ , and _____. No specific test or cures. 3 specific presentation such as: ___, ____ and ____

▫️joints, connective tissue, and viscera ▫️ systemic, polyarticular and pauciarticular (same as adults -mostly spleen)

Supplement use to manage Osteoporosis?

▫️glucosamine and chondroitin sulphate

Areas in the body mostly at risk for fracture in young adults due to sports?

Femoral shaft fracture

How do you position Client post op hip assessment?

▫️reduce edema (elevate with pillows) ▫️maintain proper alignment - avoid external rotation (pillow between knees, splint, sandbags) ▫️pain

What populations are at greater risk for disuse atrophy?

▫️elderly (frail elderly) ▫️physically disabled 🔸bcoz they don’t have the same capacity to rebuild muscle

What would be an assessment for immobility/ inactivity?

▫️assess skin integrity ▫️assess nutritional needs as they relate to immobility ▫️evaluate need for assistive devices ▫️evaluate the safety of the immediate environment